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Anthem BCBS Medical Policy Updates – January 2025
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January 2025 Anthem BCBS Medical Policy Updates:
- Ablative Techniques as a Treatment for Barretts Esophagus
- Absolute Quantitation of Myocardial Blood Flow Measurement
- Activity Therapy for Autism Spectrum Disorders and Rett Syndrome
- Acupuncture
- Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures
- Advanced Lipoprotein Testing
- Air Conduction Hearing Aids
- Alcohol Septal Ablation for Treatment of Hypertrophic Cardiomyopathy
- Allergy Immunotherapy (Subcutaneous)
- Allogeneic Xenographic Synthetic Bioengineered and Composite Products for Wound Healing and Soft Tissue Grafting
- Altered Auditory Feedback Devices for Fluency Disorders
- Ambulance Services Air and Water
- Ambulance Services Ground Emergent
- Ambulance Services Ground Non-Emergent
- Ambulatory or Outpatient Surgery Center Procedures
- Anesthesia Services and Moderate (Conscious) Sedation
- Anesthesia Services for Interventional Pain Management Procedures
- Ankle-Foot & Knee-Ankle-Foot Orthoses
- Annulus Closure After Discectomy
- Artificial Anal Sphincter for the Treatment of Severe Fecal Incontinence
- Artificial Intelligence-Based Software for Prostate Cancer Detection
- Artificial Retinal Devices
- Assistant Surgeons
- Auditory Brainstem Responses (ABRs) and Evoked Otoacoustic Emissions (OAEs) for Hearing Disorders
- Autologous and Allogeneic Pancreatic Islet Cell Transplantation
- Automated External Defibrillators for Home Use
- Automated Insulin Delivery Systems
- Automated Nerve Conduction Testing
- Autonomic Testing
- Axial Lumbar Interbody Fusion
- Back-Up Ventilators in the Home Setting
- Balloon Dilation of the Eustachian Tubes
- Bariatric Surgery and Other Treatments for Clinically Severe Obesity
- Biofeedback and Neurofeedback
- Biomagnetic Therapy
- Biomechanical Footwear Therapy
- Blepharoplasty Blepharoptosis Repair and Brow Lift
- Bone Mineral Density Testing Measurement
- Bone-Anchored and Bone Conduction Hearing Aids
- Brain Computer Interface Rehabilitation Devices
- Breast Ductal Examination and Fluid Cytology Analysis
- Breast Procedures including Reconstructive Surgery Implants and Other Breast Procedures
- Bronchial Thermoplasty
- Cancer Antigen 125 Testing
- Cancer Antigen 19-9 Testing
- Carcinoembryonic Antigen Testing
- Cardiac Contractility Modulation Therapy
- Cardiac Electrophysiological Studies (EPS) and Catheter Ablation
- Cardiac Stress Testing with Electrocardiogram
- Carotid Sinus Baroreceptor Stimulation Devices
- Carotid Vertebral and Intracranial Artery Stent Placement with or without Angioplasty
- Carpal Tunnel Decompression Surgery
- Cataract Removal Surgery for Adults
- Catheter-based Embolization Procedures for Malignant Lesions Outside the Liver
- Cell Transplantation (Mesencephalic Adrenal-Brain and Fetal Xenograft)
- Cellular Therapy Products for Allogeneic Stem Cell Transplantation
- Cervical and Thoracic Discography
- Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing
- Cervical Traction Devices for Home Use
- Chelation Therapy
- Chronic Wound Care in the Home or Outpatient Setting
- Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline Exists
- Coblation Therapies for Musculoskeletal Conditions
- Cochlear Implants and Auditory Brainstem Implants
- Colonoscopy
- Compression Devices for Lymphedema
- Continuous Glucose Monitoring Devices and External Insulin Infusion Pumps
- Continuous Local Delivery of Analgesia to Operative Sites using an Elastomeric Infusion Pump during the Post-Operative Period
- Continuous Monitoring of Intraocular Pressure
- Continuous Passive Motion Devices in the Home Setting
- Convection Enhanced Delivery of Therapeutic Agents to the Brain
- Cooling Devices and Combined Cooling Heating Devices
- Corneal Collagen Cross-Linking
- Cosmetic and Reconstructive Services of the Head and Neck
- Cosmetic and Reconstructive Services of the Trunk and Groin
- Cosmetic and Reconstructive Services Skin Related
- Cranial Remodeling Bands and Helmets (Cranial Orthotics)
- Cryoablation for Plantar Fasciitis and Plantar Fibroma
- Cryoneurolysis
- Cryopreservation of Oocytes or Ovarian Tissue
- Cryosurgical Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver
- Custodial Care
- Custom-made Knee Braces
- Deep Brain Cortical and Cerebellar Stimulation
- Destruction of Pre-Malignant Skin Lesions
- Detection of Circulating Tumor Cells
- Diagnostic Fiberoptic Flexible Laryngoscopy
- Diagnostic Infertility Surgery
- Diaphragmatic Phrenic Nerve Stimulation and Diaphragm Pacing Systems
- Digital Therapy Devices for Treatment of Amblyopia
- Donor Lymphocyte Infusion for Hematologic Malignancies after Allogeneic Hematopoietic Progenitor Cell Transplantation
- Doppler-Guided Transanal Hemorrhoidal Dearterialization
- Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain
- Drug-Eluting Devices for Maintaining Sinus Ostial Patency
- Durable Medical Equipment
- Dynamic Low-Load Prolonged-Duration Stretch Devices
- Dynamic Spinal Visualization (Including Digital Motion X-ray and Cineradiography Videofluoroscopy)
- Electric Breast Pumps
- Electric Tumor Treatment Field (TTF)
- Electrical Impedance Scanning for Cancer Detection
- Electrical Nerve Stimulation Transcutaneous Percutaneous
- Electrical Stimulation as a Treatment for Pain and Other Conditions Surface and Percutaneous Devices
- Electroencephalography and Video Electroencephalographic Monitoring
- Electromyography and Nerve Conduction Studies
- Electronic Home Visual Field Monitoring
- Electrophysiology-Guided Noninvasive Stereotactic Cardiac Radioablation
- Electrothermal Shrinkage of Joint Capsules Ligaments and Tendons
- Endometrial Ablation
- Endothelial Keratoplasty
- Enhanced External Counterpulsation in the Outpatient Setting
- Epiduroscopy
- External Ambulatory Cardiac Monitors
- External Infusion Pumps for the Administration of Drugs in the Home or Residential Care Settings
- External Insulin Pumps
- External Upper Limb Stimulation for the Treatment of Tremors
- Extracorporeal Carbon Dioxide Removal
- Extracorporeal Shock Wave Therapy
- Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis
- Eye Movement Analysis Using Non-spatial Calibration for the Diagnosis of Concussion
- Facet Joint Allograft Implants for Facet Disease
- Fecal Analysis in the Diagnosis of Intestinal Disorders
- Fetal Surgery for Prenatally Diagnosed Malformations
- Focal Laser Ablation for the Treatment of Prostate Cancer
- Foot Care Services
- Functional Electrical Stimulation (FES) Threshold Electrical Stimulation (TES)
- Functional Endoscopic Sinus Surgery (FESS)
- Fundus Photography
- Gamma Glutamyl Transferase Testing
- Gastric Electrical Stimulation
- Gene Therapy for Aromatic L-Amino Acid Decarboxylase Deficiency
- Gene Therapy for Beta Thalassemia
- Gene Therapy for Cerebral Adrenoleukodystrophy
- Gene Therapy for Duchenne Muscular Dystrophy
- Gene Therapy for Hemophilia
- Gene Therapy for Metachromatic Leukodystrophy
- Gene Therapy for Ocular Conditions
- Gene Therapy for Sickle Cell Disease
- Gene Therapy for Spinal Muscular Atrophy
- Genicular Nerve Blocks and Ablation for Chronic Knee Pain
- Heart Lung Transplantation
- Heart Transplantation
- Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors
- Hematopoietic Stem Cell Transplantation for Diabetes Mellitus
- Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias
- Hematopoietic Stem Cell Transplantation for Germ Cell Tumors
- Hematopoietic Stem Cell Transplantation for Hodgkin Disease and non-Hodgkin Lymphoma
- Hematopoietic Stem Cell Transplantation for Multiple Myeloma and Other Plasma Cell Dyscrasias
- Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors
- Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome
- Hepzato Kit (melphalan hepatic delivery system)
- High Frequency Chest Compression Devices for Airway Clearance
- High-volume Colonic Irrigation
- Home Enteral Nutrition
- Home Health
- Home Oxygen Therapy
- Home Parenteral Nutrition
- Home Phototherapy Devices for Neonatal Hyperbilirubinemia
- Hospital Beds and Accessories
- Human Chorionic Gonadotropin Testing
- Hyperbaric Oxygen Therapy (Systemic Topical)
- Hyperoxemic Reperfusion Therapy
- Idiopathic Environmental Illness (IEI)
- Immune Cell Function Assay
- Immunizations
- Implantable Ambulatory Event Monitors and Mobile Cardiac Telemetry
- Implantable Infusion Pumps
- Implantable Left Atrial Hemodynamic Monitor
- Implantable Middle Ear Hearing Aids
- Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain
- Implantable Shock Absorber for Treatment of Knee Osteoarthritis
- Implantation of Occipital Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures)
- Implanted Artificial Iris Devices
- Implanted Devices for Spinal Stenosis
- Implanted Port Delivery Systems to Treat Ocular Disease
- In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays
- Infant Home Apnea Monitors
- Ingestible Devices for the Treatment of Constipation
- Ingestion Event Monitors
- Inhaled Nitric Oxide
- Injection Treatment for Mortons Neuroma
- Inpatient Interfacility Transfers
- Intensive In-home Behavioral Health Services
- Intensive Programs for Pediatric Feeding Disorders
- Internal Rib Fixation Systems
- Interspinous Process Fixation Devices
- Intervertebral Stabilization Devices
- Intracardiac Ischemia Monitoring
- Intracytoplasmic Sperm Injection (ICSI)
- Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)
- Intraocular Telescope
- Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography
- Intraoperative Neurophysiological Monitoring
- Intrapulmonary Percussive Ventilation Devices
- Intravascular Brachytherapy (Coronary and Non-Coronary)
- Investigational Criteria
- Iontophoresis
- Keratoprosthesis
- Ketogenic Diet for Treatment of Intractable Seizures
- Laboratory Evaluation of Vitamin B12
- Laser Trabeculoplasty and Laser Peripheral Iridotomy
- Laser Treatment for Onychomycosis
- Lifting Devices for Use in the Home
- Lingual Frenotomy for Ankyloglossia-Related Feeding Difficulties
- Liver Transplantation
- Locoregional and Surgical Techniques for Treating Primary and Metastatic Liver Malignancies
- Lower Esophageal Sphincter Augmentation Devices for the Treatment of Gastroesophageal Reflux Disease (GERD)
- Lower Limb Prosthesis
- Low-Frequency Ultrasound Therapy for Wound Management
- Lumbar Discography
- Lung and Lobar Transplantation
- Lysis of Epidural Adhesions
- Machine Learning Derived Probability Score for Rapid Kidney Function Decline
- Magnetic Resonance Neurography
- Magnetization-Prepared Rapid Acquisition Gradient Echo Magnetic Resonance Imaging (MPRAGE MRI)
- Mandibular Maxillary (Orthognathic) Surgery
- Manipulation Under Anesthesia
- Mastectomy for Gynecomastia
- Maze Procedure
- Mechanical Circulatory Assist Devices (Ventricular Assist Devices Percutaneous Ventricular Assist Devices and Artificial Hearts)
- Mechanical Embolectomy for Treatment of Stroke
- Mechanical Insufflation-Exsufflation Devices
- Mechanized Spinal Distraction Therapy
- Medical Necessity Criteria
- Medical Policy Formation
- Metagenomic Sequencing for Infectious Disease in the Outpatient Setting
- Microprocessor Controlled Knee-Ankle-Foot Orthosis
- Microprocessor Controlled Lower Limb Prosthesis
- Microsurgical Procedures for the Prevention or Treatment of Lymphedema
- Minimally Invasive Ablative Procedures for Epilepsy
- Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis
- Mobile Device-Based Health Management Applications
- Moderate to Deep Anesthesia Services for Dental Surgery in the Facility Setting
- Mohs Micrographic Surgery
- Molecular Gastrointestinal Pathogen Panel (GIPP) Testing for Infectious Diarrhea in the Outpatient Setting
- Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy
- Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures
- MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications
- Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis
- Multiplex Autoantigen Microarray Testing for Systemic Lupus Erythematosus
- Myocardial Strain Imaging
- Myocardial Sympathetic Innervation Imaging with or without Single-Photon Emission Computed Tomography (SPECT)
- Myoelectric Upper Extremity Prosthetic Devices
- Myringotomy and Tympanostomy Tube Insertion
- Nanoparticle-Mediated Thermal Ablation
- Nasal Surgery for the Treatment of Obstructive Sleep Apnea and Snoring
- Nasal Valve Repair
- Navigational Bronchoscopy
- Near-Infrared Coronary Imaging and Near-Infrared Intravascular Ultrasound Coronary Imaging
- Near-Infrared Spectroscopy Scanning for Brain Hematoma Screening
- Neonatal Levels of Care
- Nerve Graft after Prostatectomy
- Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring
- Neuromuscular Stimulation in the Treatment of Muscle Atrophy
- Neutron Beam Radiotherapy
- Noninvasive Electrical Bone Growth Stimulation of the Appendicular Skeleton
- Non-invasive Heart Failure and Arrhythmia Management and Monitoring System
- Noninvasive Home Ventilator Therapy for Respiratory Failure
- Non-invasive Measurement of Advanced Glycation End Products (AGEs) in the Skin
- Non-Invasive Measurement of Left Ventricular End Diastolic Pressure in the Outpatient Setting
- Non-Obstetric Gynecologic Duplex Ultrasonography of the Abdomen and Pelvis in the Outpatient Setting
- Non-Obstetrical Transvaginal Ultrasonography
- Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Bacterial Vaginosis
- Occipital Nerve Block Therapy for the Treatment of Headache and Occipital Neuralgia
- Open Sacroiliac Joint Fusion
- Ophthalmic use of NdYAG Laser for Posterior Capsulotomy
- Optical Detection for Screening and Identification of Cervical Cancer
- Orthopedic Footwear
- Osseointegrated Limb Prostheses
- Outpatient Alpha-Fetoprotein Testing
- Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management
- Outpatient Cardiac Rehabilitation
- Outpatient Cystourethroscopy
- Outpatient Glycated Hemoglobin and Protein Testing
- Outpatient Laboratory-based Blood Glucose Testing
- Outpatient Urine Culture
- Pain Management Biomarker Analysis
- Pancreas Transplantation and Pancreas Kidney Transplantation
- Panniculectomy and Abdominoplasty
- Paraesophageal Hernia Repair
- Partial Left Ventriculectomy
- Patent Foramen Ovale and Left Atrial Appendage Closure Devices for Stroke Prevention
- Pediatric Gait Trainers
- Penile Circumcision
- Penile Prosthesis Implantation
- Per- and Polyfluoroalkyl Substances (PFAS) Testing
- Percutaneous and Endoscopic Spinal Surgery
- Percutaneous Ultrasonic Ablation of Soft Tissue
- Percutaneous Vertebral Disc and Vertebral Endplate Procedures
- Peripheral Nerve Blocks for Treatment of Neuropathic Pain
- Physiologic Recording of Tremor using Accelerometer(s) and Gyroscope(s)
- Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting
- Pooled Antibiotic Sensitivity Testing
- Portable Normothermic Organ Perfusion Systems
- Posterior Segment Optical Coherence Tomography
- Powered Robotic Lower Body Exoskeleton Devices
- Powered Wheeled Mobility Devices
- Prefabricated and Prophylactic Knee Braces
- Prefabricated External Infant Ear Molding Systems
- Preoperative Testing for Low Risk Invasive Procedures and Surgeries
- Pressure Reducing Support Surfaces – Groups 1 2 & 3
- Private Duty Nursing in the Home Setting
- Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease
- Prostate Saturation Biopsy
- Prostate Specific Antigen Testing
- Protein Biomarkers for the Screening Detection and Management of Prostate Cancer
- Prothrombin Time Self-Monitoring Devices
- Pulmonary Rehabilitation
- Quantitative Muscle Testing Devices
- Quantitative Sensory Testing
- Quantitative Ultrasound for Tissue Characterization
- Radioactive Seed Localization of Nonpalpable Breast Lesions
- Radiofrequency Ablation of the Renal Sympathetic Nerves
- Radiostereometric Analysis (RSA)
- Red Blood Cell Folic Acid Testing
- Reduction Mammaplasty
- Refractive Surgery
- Rehabilitative and Habilitative Services in the Home Setting Physical Medicine Physical Therapy Occupational Therapy and Speech-Language Pathology
- Rehabilitative Devices with Remote Monitoring
- Remote Devices for Intermittent Monitoring of Intraocular Pressure
- Remote Therapeutic and Physiologic Monitoring Services
- Respiratory Viral Panel Testing in the Outpatient Setting
- Resting Electrocardiogram Screening in Adults
- Review of Services for Benefit Determinations in the Absence of a Company Applicable Medical Policy or Clinical Utilization Management (UM) Guideline
- Rhinophototherapy
- Robotic Arm Assistive Devices
- Rupture of Membranes Testing in Pregnancy
- Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence Urinary Retention
- Sacral Nerve Stimulation as a Treatment of Neurogenic Bladder Secondary to Spinal Cord Injury
- Scoliosis Surgery
- Screening for Vitamin D Deficiency in Average Risk Individuals
- Seat Lift Mechanisms
- Selected Blood Serum and Cellular Allergy and Toxicity Tests
- Selected Protein Biomarker Algorithmic Assays
- Selected Sleep Testing Services
- Self-Expanding Absorptive Sinus Ostial Dilation
- Self-Operated Spinal Unloading Devices
- Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State
- Septoplasty
- Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS)
- Serological Antibody Testing For Helicobacter Pylori
- Serum Amylase Testing
- Serum Biomarker Tests for Multiple Sclerosis
- Serum Biomarker Tests for Risk of Preeclampsia
- Silver-based Products for Wound and Soft Tissue Applications
- Site of Care Specialty Pharmaceuticals
- Skilled Nursing and Skilled Rehabilitation Services (Outpatient)
- Skin Nerve Fiber Density Testing
- Small Bowel Small Bowel Liver and Multivisceral Transplantation
- Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy
- Spinal Orthoses Thoracic-Lumbar-Sacral (TLSO) Lumbar-Sacral (LSO) and Lumbar
- Standing Frames
- Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices
- Strapping
- Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring
- Surgical and Ablative Treatments for Chronic Headaches
- Surgical Strabismus Correction
- Surgical Treatment for Dupuytren’s Contracture
- Surgical Treatment of Hyperhidrosis
- Systems Pathology Testing for Prostate Cancer
- Technologies for the Evaluation of Skin Lesions (including Dermatoscopy Epiluminescence Microscopy Videomicroscopy and Ultrasonography)
- Temporomandibular Disorders
- Testing for Biochemical Markers for Alzheimers Disease
- Testing for Oral and Esophageal Cancer
- Therapeutic Apheresis
- Therapeutic Shoes Inserts or Modifications for Individuals with Diabetes
- Therapeutic use of Stem Cells Blood and Bone Marrow Products
- Three-Dimensional (3-D) Rendering of Imaging Studies
- Thymus Tissue Transplantation
- Thyroid Testing
- Tonsillectomy for Children with or without Adenoidectomy
- Tonsillectomy with or without Adenoidectomy for Adults
- Transanal Endoscopic Microsurgical (TEM) Excision of Rectal Lesions
- Transanal Irrigation
- Transanal Radiofrequency Treatment of Fecal Incontinence
- Transcatheter Ablation of Arrhythmogenic Foci in the Pulmonary Veins
- Transcatheter Heart Valve Procedures
- Transcatheter Uterine Artery Embolization
- Transendoscopic Therapy for Gastroesophageal Reflux Disease Dysphagia and Gastroparesis
- Transmyocardial Perventricular Device Closure of Ventricular Septal Defects
- Transmyocardial Revascularization
- Transrectal Ultrasonography
- Treatment of Keloids and Scar Revision
- Treatment of Varicose Veins (Lower Extremities)
- Treatments for Urinary Incontinence
- Trigger Point Injections
- Tropism Testing for HIV Management
- Ultrafiltration in Decompensated Heart Failure
- Ultrasonic Diathermy Devices
- Ultrasound Ablation for Oncologic Indications
- Ultrasound Bone Growth Stimulation
- Ultraviolet Light Therapy Delivery Devices for Home Use
- Umbilical Cord Blood Progenitor Cell Collection Storage and Transplantation
- Upper Extremity Myoelectric Orthoses
- Upper Gastrointestinal Endoscopy in Adults
- Use of 3-D 4-D or 5-D Ultrasound in Maternity Care
- Uterine Fibroid Ablation Laparoscopic Percutaneous or Transcervical Image Guided Techniques
- Uterine Transplantation
- Vacuum Assisted Wound Therapy in the Outpatient Setting
- Vagus Nerve Stimulation
- Vein Embolization as a Treatment for Pelvic Congestion Syndrome and Varicocele
- Vestibular Function Testing
- Virtual Reality-Assisted Therapy Systems
- Wearable Cardioverter Defibrillators
- Wearable Devices for Stress Relief and Management
- Wheeled Mobility Devices Manual Wheelchairs – Standard Heavy Duty and Lightweight
- Wheeled Mobility Devices Manual Wheelchairs-Ultra Lightweight
- Wheeled Mobility Devices Wheelchair Accessories
- Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility Disorders
- Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing
- Zika Virus Testing
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